Korean J Intern Med.  2012 Jun;27(2):203-210. 10.3904/kjim.2012.27.2.203.

Causes and Treatment Outcomes of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 82 Adult Patients

• Kim HI
• Kim SW
• Park GY
• Kwon EG
• Kim HH
• Jeong JY
• Chang HH
• Lee JM
• Kim NS

• KMID: 1776548
• DOI: http://doi.org/10.3904/kjim.2012.27.2.203

Abstract

BACKGROUND/AIMS
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses.
METHODS
The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed.
RESULTS
A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009).
CONCLUSIONS
Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.

Keyword

Stevens-Johnson syndrome; Epidermal necrolysis, toxic; Etiology; Prognosis

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Epidermal Necrolysis, Toxic/diagnosis/*etiology/mortality/*therapy
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Republic of Korea
Risk Assessment
Risk Factors
Stevens-Johnson Syndrome/chemically induced/diagnosis/*etiology/mortality/*therapy
Survival Analysis
Treatment Outcome
Young Adult